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Clinician's Digest - Page 4

What Works for Addictions Treatment?

The term mindfulness—cultivating the ability to notice and calmly, nonjudgmentally observe your emotions—is ubiquitous in the therapy field today. It filters into approaches across the theoretical spectrum, from Cognitive-Behavioral Therapy to humanistic, client-centered treatments. So far, positive results of using mindfulness in treatment have been reported with conditions as varied as anxiety, depression, and even personality disorders. But what about addictions?  With compulsive behavior, how effective is nonjudgmental witnessing and acceptance?

G. Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington, came to embrace a mindfulness approach to addiction treatment by accident. Originally a strict behavioral psychologist, in the days when meditation was associated mostly with Eastern wannabes and acolytes of the Maharishi Mahesh Yogi, Marlatt first tried meditation after he was encouraged to do so to reduce his high blood pressure. Skeptically, but curiously, he tried it, and got positive results. From there, he began to apply it to psychological issues. Eventually, he developed a treatment for addiction that combines Motivational Interviewing (MI) and mindfulness.

MI encourages clients to set their own goals around substance use, and then to examine how their behavior fits their goals. The mindfulness component teaches clients not to deny or try to stamp out their urges to use, but rather, to pay attention to compulsive urges and breathe into them while remaining calm and nonreactive. After years of working with this treatment approach, Marlatt came to appreciate the value of helping clients "surf their urge"—experiencing it as a wave that will rise and fall, and using their breath as a "surfboard."

For Marlatt, the core problem with many abstinence-based approaches to addiction treatment is that once you define occasional use as relapse and failure, you trigger the same feelings of shame and hopelessness that originally led people down the path to addiction. He prefers the term "prolapsed," a more positive term that allows clients to view their renewed use as an opportunity for further practice in living in alignment with their goals.

Marlatt believes that the main goal in addictions treatment is helping clients find what works for them, citing the massive Project Match research study of several years ago, which found that no addictions treatment approach is superior to all others. "No two individuals are identical, so it makes sense that no two recoveries or treatments are identical," he says.


Virtual Visitation: For more information on VV, see; Resurrecting Therapy: other information on psychotropic meds at; Archives of General Psychiatry 67, no. 12 (December 2010): 1208-1327.

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